The New Face of Richard Norris

For fifteen years, Richard Norris had a face too hideous to show. Then, one day, a maverick doctor gave him a miracle too fantastic to believe. Richard got a face transplant, a new life, and a new set of burdens too strange to predict. What's it like to live with a face that wasn't yours—and that may never quite be?

Before we bring him in, maybe we can open the floor to some questions. This will be your first time meeting him. He’s very comfortable with people evaluating him. Because right now he’s being looked at almost as an experiment. Which he is. He’s a human-subjects experiment.

Richard Norris was 22 when he shot himself in the face. This was back in 1997. He doesn’t remember how or why it happened, but his mom, who was three feet away, said it was an accident. She remembers pieces of Richard’s face showering her body. This was in the living room. The gunshot had blown off his nose, cheekbones, lips, tongue, teeth, jaw, and chin, leaving just his wide brown eyes and a swirl of nameless twisted flesh.

The miracle that would come to define Richard’s life begins with these tragic details. Like most miracles, with each retelling, the edges of the story sharpen, the colors become more vibrant, and the shadows disappear. Ashamed of his appearance, Richard became a hermit, living for nearly a decade on a foggy mountaintop in rural Virginia with his parents. They covered the mirrors in the house so Richard wouldn’t have to look at his hideous face. He stayed in his room even to eat, wore a black mask on the rare occasions he came out. According to legend, one time the cops stopped him at gunpoint, mistaking him for a robber.

Then one day, searching on the Internet, his mom found Eduardo Rodriguez, a Baltimore reconstructive facial surgeon. He promised Richard he would make him normal. Over the next few years, Rodriguez performed dozens of surgeries using Richard’s own flesh, fashioning a nose-shaped appendage out of tissue from his forearm and a small chin out of flesh from his legs, but these crude approximations failed to make Richard normal. Meantime, Rodriguez had a grander idea in mind. He was driven to achieve perfection. He had been practicing face transplants on cadavers. What he envisioned for Richard was the most extensive transplant any surgeon had ever attempted: He would give Richard a whole new face.

"It’s showtime," Rodriguez said one day.

"You’re my godsend," Richard’s mom said.

"Let’s do this thing," Richard said.

The surgery started at dawn on March 19, 2012. The face of a recently deceased 21-year-old man came off as one solid flap, skin, muscle, bone, nerves, blood vessels, tongue—everything as one piece. Rodriguez removed what was left of Richard’s disfigured face, dissected down to the skull. He attached the new face midway back on Richard’s scalp. He stabilized it with screws, tapped the jaw together, and finally draped the skin and sewed it down like a patch on a coat or a pair of jeans.

You can see the junction; the incision actually goes here in the coronal, extends in front of the ear, and goes posteriorly all the way down, uh, to the neck.

Rodriguez and his team worked nonstop for thirty-six hours, and when they were finished, Richard’s mom looked at her son and felt like he was somehow resurrected. "We have Richard back!" she said on the phone to Richard’s dad, who had not had much of anything to say for many years.

With his new face, Richard, now 39, became a media sensation for a time, the story of the miracle told many times over until it hardened even in Richard’s mind into a kind of precious jewel.

Maybe we can scroll through some of the clinical photographs while we’re talking. I feel very happy about the bony union here. That’s the donor palate. And that’s the donor floor mouth. The donor hair, it’s a little darker than his. His is a little bit more salt-and-pepper.

Most of the thirty or so people gathered in the conference room are wearing white coats or lanyards or both, and they sit visibly captivated by the photographs Rodriguez is describing. The mood is electric, scrambled, like a show on opening night. The pictures show Richard, who’s waiting in an adjacent room for his cue to enter. The expectation lends an extra edge of drama to the presentation. He’s flown up here to New York from the foggy mountaintop where he still lives, so that the assembled doctors and other clinicians at NYU Langone Medical Center can meet him.

Rodriguez is an imposing figure, tall and broad, with a big dimple on his giant chin, wide pinstripes, cuff links, and unbuckled galoshes affecting a disheveled nonchalance. In the wake of his world-famous work on Richard, he was just named NYU’s chair of plastic surgery, a substantial professional promotion ("like I’ve just been handed the keys to the starship Enterprise," he told me). In part, he’s been hired to get NYU into the face-transplant business, and today, as the hospital begins the process for its first one, he’s brought his star patient before his new colleagues.

One of the things you’ll notice is he has a couple of these scratches. He tends to pick and scratch a bit.

Since the first face transplant, in 2005, only three American hospitals have performed the procedure. Many of the twenty-eight transplants were partial, sections of the face transplanted from deceased donors. Richard’s transplant was a full face and is said to be the most ambitious ever. Rodriguez likens the medically complex procedure to the Apollo moon landing.

Surgical difficulty aside, the fact that Richard didn’t need a new face to survive raised an ethically grim question: Is a "life-enhancing" surgery worth the risk? There was a good chance he’d die—either on the operating table or later, if his body rejected the face. Of course, for people disfigured like Richard, the breakthrough represents something far beyond a mere enhancement. Here was new hope for millions of people disfigured by trauma, burns, disease, or birth defects. Wounded warriors suffering ballistic facial injuries would now have a surgical option that would go light-years beyond the currently available treatments. No more Band-Aid cosmetic surgeries. No more skin grafts that might only complicate your appearance. Now you could get rid of that face and replace it whole. "We’ve gone beyond the boundary of what we thought was even possible," Rodriguez tells me.

One by one, some of the specialists in the conference room who had a chance to evaluate Richard earlier today stand up to speak of their findings. Concerns emerge, principally about Richard’s state of mind. Has he become too emotionally attached to Rodriguez, the medical attention, the fame? What will happen to him now that Rodriguez has moved on to a new hospital, new face transplants, new miracles?

We were both struck by how good he looks and the really excellent aesthetic result.

He reported to me no chewing or swallowing problems.

I was having trouble understanding him.

I asked: Do people understand you? Are you mostly intelligible?

He hasn’t done any ercises.

He said he just wants to move on, do his own thing.

I think he’s maybe overwhelmed, like you said.

He is not in any kind of psychotherapy.

He seems to have somewhat habituated to all the media attention.

He’s sort of had this Mick Jagger status.

He feels there’s a sense of abandonment.

I did not get the sense that he was open to therapy at this time.

In terms of any concerns about suicidality or low mood, severe depression, I would say that he denies it. I don’t know fully if that’s exactly accurate. I would want to speak with him again.

When Rodriguez gives the nod, the door flies open and Richard saunters in, dressed in a bright purple Baltimore Ravens hat and jacket. He’s been living with his new face for two years now, and he’s undeniably attractive—clean-shaven, youthful, the kind of guy you would hire to run the front office. He takes a seat facing the crowd, arms splayed out, cool as Justin Bieber on a late-night talk show. Everyone stares at him, and some cock their heads. He’s used to this; sometimes people applaud. Is he smiling? His new face doesn’t move a lot. Does it move at all? He might be smiling, or it might just be the will of the room. His eyes, the one part of his original face still intact, dart like anyone’s eyes, and I find myself chasing them, the only reliable clue as to what might really be going on in there.

One of the things I wanted to know when I first reached out to Richard was how he felt about the miracle. What was it like to walk around with someone else’s face? I thought it might be kind of unsettling, or confusing. You’re chewing with another man’s teeth? When I wrote to him to ask, he told me he had an agent. Cal Ripken’s agent, he pointed out. He said everything about his new face was great. He has received thousands of letters from fans. One of the fans is now his girlfriend. She lives in New Orleans. He said he was planning to go meet her in person. He said he was in college now, wanted to focus on school, on being normal. Then he invited me to the foggy mountaintop. The fog was famous, he said, had recently made national news when it caused seventeen pileups involving ninety-five vehicles in one night.

When I get there, the sun has already burned the fog off the morning, which is oddly disappointing. Richard’s house isn’t actually at the top of the mountain. There’s a street carved about midway up with a dozen or so homes, and his is a small yellow double-wide with red trim, a carport, and a for sale sign out front. The storm door has a bear etched into the glass. Richard opens it and welcomes me inside. He’s wearing a black Under Armour shirt and cargo pants and he’s thin, old-man thin. His posture has curved into a slump from years of hanging his head low, from years spent feeling he was hideous to look at, so now he has to make a conscious effort to stand up straight.

He seems nervous. His hands tremble, bringing constant sips of water to his mouth. His lips can’t quite grip the bottle, so each sip is more a little pour. He fights a constant drool with the help of a towel. His new face is a marvel nonetheless. It’s a new face. Wide and open, the cheekbones of an Irishman and the wrinkle-free complexion of a college kid. It’s difficult to reconcile the youthful face with the body of a man nearly 40. I am trying not to stare. I am trying to stop looking for the seams, where the new connects to the old, the eyelids, the neck, the scar in front of his ears. I am trying to stop thinking about his beard, which isn’t really his beard, except now it is, and it grows. I’m distracted by a thousand little thoughts like these. Coupled with his lack of facial expression—a solid, largely unmoving veneer—in all these ways the barrier to getting to know Richard feels to me immediately and appreciably steep. Microexpressions, split-second movements of the face, are said to communicate wide arrays of meaning. Even infants who are blind are said to use facial cues to tell their parents how they feel. You don’t recognize how true these theories likely are until you are with someone with a face frozen in place.

"Here you go," Richard says, picking up a DVD. It’s a copy of the hour-long TV special Ann Curry did about him. He takes a Sharpie from his pocket, signs his name on the DVD, hands it to me.

It’s a little bit awkward. I don’t know where to begin. A face is a surprisingly intimate and complex subject. Part personal, part public. Partly a thing, partly an idea. Part physiology, part psychology.

Richard leads me through the living room past his mother, who is on a recliner, staring into a laptop. She does not look up. He shows me his room. It’s neat as a hotel. No clutter. Just pictures on the walls, every newspaper and magazine article ever written about him, each of them framed. "They even did me on Ripley’s Believe It or Not!," he says, pointing to one of his clippings. "In Japan I got rated in the top fifty miracles."

I ask him about school, how it’s going, how it feels to interact with students. Do they know he has a new face?

"I don’t have any classes right now," he says. His voice is muffled, like it’s coming from the same place his eyes are, somewhere deep inside. New lips, new mouth, new tongue—it’s remarkable he can form words at all. He says he’s between classes. At the moment. Well, he isn’t actually in school. He’s taken some online courses. A lot of what Richard presents to the world is vague. The girlfriend. He says they’re soul mates, but so far she’s still just a Facebook profile. He says they text all the time. He can’t wait to meet her in person.

He leads me back into the living room, where his mom is poking her keyboard angrily. He leaves me here. Two dachshunds sniff at my feet.

"So you like my two little wieners, huh?" his mom says to me, closing her laptop. She has a round face surrounded by gray curls, a soft neck, wide arms. "That one is Raven and that one is Mark—after the race-car driver. She’s spoiled rotten. Mark is, too. He’s got cancer."

Raven climbs a set of doggie steps up to the couch, digs intently at a blanket, around and around, until she has made herself a cocoon fully covering her body, with just her little nose popping out.

I compliment Richard’s mom on the house, the homey feeling, the beautiful views off the back deck.

"You want to buy it?" she asks. It was a mistake moving up here, she says. She never liked it, and neither did Richard. The old house, they gave it to Richard’s sister, because she was having trouble making rent. "We’re below poverty line," she says. She invites me to sit down on an adjacent recliner. "I have fibromyalgia," she says. "That’s why I have these heated blankets."

Richard comes back, carrying pill bottles. "This is what I take every day," he says. "These are my pills." It’s a five-pill maintenance regimen he’ll need to keep up for the rest of his life; his body will always regard his new face as a foreign object, prompting his immune system to constantly attack it. The drugs trick the immune system by kicking it into its lowest possible gear. This leaves Richard vulnerable to every conceivable health problem down the line. Cancer, diabetes—all the majors.

"He’s not supposed to smoke," his mom says. He can’t get sunburn. He can’t get a cold. He can’t drink. He can’t fall and risk injury. He can’t afford to tax his immune system at all. Even a cut could trigger rejection. It starts as a blotchy rash; it means his body is winning the fight to reject the transplant, and Richard has to be flown to the hospital to receive rounds of emergency drugs intravenously. Uncontrollable rejection would mean an almost certain death; the only things left of Richard’s old face are his eyes and the back of his throat. Everything else is now gone for good. "I have to keep watch that his face doesn’t go yellow," his mom says. "He’s had two rejections so far."

"I’ll leave you two talking," Richard says, and he heads outside for a smoke.

His mom motions toward the mantel on the fireplace, where two framed photographs stand side by side. One is Richard’s high school portrait. The other is Josh, the 21-year-old donor, who used to have the face Richard now has.

"Isn’t that amazing?" she says of the resemblance.

It really is. I don’t know which is which, who is which, or what. Pronoun problems emerge. I didn’t know Richard as a young man, and now the young face of one is attached to the aged body of the other.

"The likeness?" she says. "It’s Richard." She tells me she met Josh’s mom, visited her at her home. "Real down-to-earth person. I said, ’I really like your kitchen.’ That was the kitchen I wanted. Island in the middle of it. Her cabinets had glass in them. I said, ’I’m gonna have to get Eddie to make me a kitchen like that.’ "

Eddie is Richard’s dad. He used to be a long-haul trucker, but he had to quit when he started needing insulin. He was not in favor of the idea of Richard getting a face transplant. "I like your regular face," he said at the time. Richard’s mom told him to back off. "It’s Richard’s choice," she said. Rodriguez told Richard and his parents that the surgery would be extremely risky—it would take a day and a half—and that Richard would have only a 50 percent chance of surviving it. "And he told us that if the face transplant didn’t take, Richard would die because there would be nothing of his old face left," his mother tells me. "But it worked out great."

I ask her if she thinks Richard has changed since his surgery. Does she see a big difference in his personality?

"Yeah, he gets out a little more than what he did," she says. Which still isn’t a whole lot. He can’t drive, because he could have seizures. She can’t drive on account of her fibromyalgia. So the two of them are mostly stuck here, dependent on Eddie.

I lean up in the recliner, stretch my legs out straight. Right now this story is not screaming: miracle.

"What Richard is, he’s a lab rat," she says. "He gets to be a brat sometimes. Gets on my nerves so bad. I’ve always told my kids I don’t care if I’m 95 years old, if you do something I don’t think you should, I’ll climb up on a chair and I’ll slap you good."

I ask her what she means by "lab rat," and she says exactly that: an animal people do experiments on. "Lab rat," she says. "I don’t think he’ll ever be able to work like in a normal life. He spends his time in hospitals, everybody poking and prodding, studying him. A boss don’t want somebody that’s gonna be absent 99 percent of the time."

She says Richard doesn’t complain about being a lab rat. He’ll do anything for Rodriguez, and so will she.

"Did you meet Dr. Rodriguez?" she asks me. "Me and the nurses, we said, ’Yeah, he sure is good candy-looking stuff.’ "

Rodriguez, 47, didn’t start out wanting to be great. Or not this great. He was in dental school. His parents had emigrated from Cuba. A Miami drill, fill, and bill dentist—that was his destination.

He speaks in the present tense when he talks about his past. "It’s this pursuit of understanding," he tells me, sucking on a peppermint. "Pursuit of knowledge." He tells me about medical school after dental school. General surgery. Plastic surgery. Microsurgery. "Pursuit of being better. Aim for excellence. I think humility is an important factor." He discovered in himself all the components of a star surgeon, and he could not quiet his urge to learn: "Like being in a library and you keep looking, and it leads you to another thing and you keep going." Soon he’s in surgery heaven, in Taipei, Taiwan, Chang Gung Memorial Hospital, a mecca for craniofacial and microsurgery, ninety-nine operating rooms, reattaching fingers, attaching toes to hands, round-the-clock microsurgery, free flaps—taking tissue from one part of a person’s body and attaching it to another—a hundred free flaps every single month. "Crank it up," Rodriguez tells me, bouncing his head with the memory. "Push and push and push."

Eventually he comes home, accepts a post in Baltimore at the University of Maryland Shock Trauma Center. "Now I’m treating soldiers. Gunshot wounds. Explosions," he tells me. He’s fixing faces. A guy needs a nose; Rodriguez takes flesh from his leg and makes him a nose, a chin, a cheek. "Everything is, like, happening now. These patients start coming out of the woodwork. ’There’s this crazy guy in Baltimore; I think he might help you.’ It’s like Doctor Dolittle. People just come from everywhere."

But there are limitations, sculpture-wise, when it comes to making a nose. It would be so much better to put a real nose on someone. People had of course been doing organ transplants for years. But a face is a whole new ball game.

A face isn’t an organ, like a liver or a heart. A face is muscles, nerves, bones, and skin. A face is more like a hand or a foot. These kinds of transplants, composite-tissue transplants, sparked a fiery ethical debate from the beginning, back in 1998, when the first successful hand transplant occurred. This sort of surgery was, after all, elective surgery. Would it be worth the risk that a lifetime of immunosuppressant drugs would present? Composite-tissue transplantation became a reality when Clint Hallam, a 48-year-old man from New Zealand, got a new hand that was bigger and pinker than his other hand. But it was a hand. If they could do a hand, what about a face? Should they?

Hallam’s own experience was not particularly encouraging. The new hand freaked him out. One hand his, one hand somebody else’s. He couldn’t handle it. "Take if off," he said to his doctors. They refused. He persisted. They refused. So he stopped taking his meds, hid the hand from view so no one could tell what was happening to it. Doctors ended up having to amputate what was left. A mess. How stupid can you get? Hallam, they said, was a psychopath. Physical rejection may be a conundrum, but psychological rejection was the stuff of madmen.

In 2003, the Royal College of Surgeons of England, and a year later, a national ethics committee in France, said that face transplantation would be going too far. The risk of complication would far outweigh the benefits. A new hand might be a reversible decision. But a new face? Once you take your old face off, you’re committed. You live your whole life like that, taking medications to keep your new face on so you don’t die. All this, for elective surgery?

Nevertheless, the first face transplant was performed in France in 2005. It caught the surgical world by surprise. It was a partial, a triangle. The nose and lips from a deceased donor were removed and sewn onto a woman whose face had been bitten off by a dog. Everyone had thought the first face transplant would be done in the U.S. Just a year earlier, the Cleveland Clinic had gotten ethical approval and had started testing prospective patients. But then France did it first, and the worldwide race to do something bigger, better, was on.

Meanwhile, Rodriguez—with all the cowboys in his field now talking face transplants—is imagining something bolder than what’s been tried. He’s practicing on cadavers, taking the face off one and putting it on another, not just the triangle but the whole face. He isn’t sure about the procedure. Could he do it? Like a fighter pilot on a flight simulator, he practices the surgery on his computer. He’s got all his training behind him, and all the technology before him, and he’s looking at Richard. He’s looking at two or three other people who might be good candidates. "But I’m not totally convinced yet," he tells me, still engrossed in the unfolding dramatization of his life. "I’m apprehensive about it. I think it’s a big deal. Taking someone’s face off." There is no turning back once you do something like that. The old face is mangled and useless; you can’t put it back on. "I’m thinking about it very systematically."

He tells me about going to Paris, having lunch with Pascal Coler, a 30-year-old man who got a new face in 2008. Coler had lived with big tumors all over his face. A terrible life. "And I have a very good steak tartare," Rodriguez says. "And next to me is Pascal, chowing down the biggest porterhouse. As normal as can be. No one looks at him. He has a job, a potential girlfriend. I’m like, holy mackerel, this is huge. We’ve gone beyond clinical; now we can change someone’s life."

I want to ask Rodriguez how one patient who seemed reasonably content during one meal is enough to quiet an entire internal moral crisis, but he’s on fast-forward, the adventure playing out like an action movie.

"Let’s go!" he tells me. "It’s on!"

So in Baltimore, a team of five surgeons are mobilized—two to work on the donor, three on Richard—and the operating rooms are readied. "I go, ’Richard, if you want to pull the plug right now, do it,’ " says Rodriguez. " ’I don’t want you to feel any pressure; there’s a lot going on here, and I just need you to tell me right now if you’re ready, and if you aren’t, we just walk away and it’s all good.’

The surgery, which started with incisions from Richard’s scalp to his neck, began at dawn on March 19, 2012, and continued nonstop for the next thirty-six hours.
Richard’s old face was removed to expose his skull, eye sockets, and throat and neck muscles.
The donor face was applied in one solid piece that included the jaw, tongue, muscles, skin, nose, teeth, and eyelids.
Hammers and saws were used to shape Richard’s new jaw. Metal plates stabilized the donor face and allowed doctors to attach it to Richard’s skull with screws.

"He said, ’Let’s go. We’re doing it.’ That’s it. You get yourself in your mental game. It’s fourth and goal, and we are going into the end zone. We’re going to win the Super Bowl. This is the moment of no return. Complete silence in the room; like, holy mackerel. Tough moment. No failure. This is it. We’re going to make this thing. The face is one unit. I’m picking it up. I’m laying it on him. I’ve got to get everything centered, it can’t be off-kilter, the nose has gotta be straight, everything’s gotta land perfectly.

"Now, this organ is not receiving blood. It needs to receive blood. The longer it takes to receive blood increases the chance for acute rejection. We gotta get this thing drinking.

"Connecting the artery, then the vein, and then we release, and it really is like a miracle. Impressive. You see the blood just coming from the neck, crossing the lips. Seeing the nose—it’s white and it turns pink, like normal flesh. It takes seconds. And now we’re thinking, Okay, I can take a little breather, but we still have to push ahead, I have to get Richard out of the operating room. We still have to connect the nerves, a lot of nerves. We have to suture the inside of his mouth and tongue; everything has to be sutured. And fix the rest of the bones. Line up the soft tissue. Line up his hairline. Line up his eyebrows. Get the eyelids. So all that needs to happen.

"We’re at about eighteen to twenty hours. We’ve still got a lot to go. I predicted twenty-four to thirty-six hours. I think the unique thing about this face transplant is that it was so extensive and comprehensive. I say this very humble, up to that point, nothing of that level had been performed."

Doubt, when it comes to miracles, is like steam on a mirror. You have to wipe it off if you want to see anything. And what choice do you have? You’ve already moved forward. You’ve given a guy a new face. You’ve gotten a new face. Your kid has a new face. There is no turning back.

One day on the foggy mountaintop, Richard and I get bored sitting around his house, so we decide to take a drive. He is a man of hard-earned platitudes. "Sometimes God will put you on your back to make you look up. Sometimes you need that nudge." He’s grateful for his new face. He’s grateful to Josh, the donor. Five other people are now living with organs from Josh. "It helps you understand...I’m not going to say the afterlife, but what you do here on earth and what you leave here on earth—it’s totally two different things." He tells me about his efforts to raise awareness for organ donation; he’s become something of a national spokesman for the cause.

In the car, we talk about all the fun things we’ll do on our drive. His sister lives about an hour away, in the house Richard grew up in, the house where this whole mess started fifteen years ago, when he shot himself in the face. We haven’t talked much about the accident. He doesn’t remember anything. Morning or night, nothing. "It’s just a cobweb." He suggests we stop at a beautiful lookout place, too. First, though, he asks me to stop at a store. "Something for my throat," he says. He comes out of the store carrying a brown bag. We continue our journey, go up into the voluminous mountains rolling every which way you look.

We talk about cracked iPhones. He’s going to start a business fixing cracked iPhones. We talk about his girlfriend. "Melanie," he says, pulling up a picture of her as if to offer proof. "She’s real." He can’t wait to meet her in person. We talk about being a lab rat. On this matter he says he’s honored. In a way, his whole life has been volunteering. When he was in high school, he was a volunteer firefighter. Now, with his new face, doctors are learning so much about how to treat soldiers suffering ballistic facial injuries. He likes helping people. He likes giving people hope. "A drop of hope can create an ocean," he says. "But a bucket of faith can create an entire world."

"That’s true," I say.

"My throat," he says. We’re getting higher, and my ears have popped. He’s stretched out, relad. He reaches into the brown bag, pulls out a bottle of Wild Turkey.

"For my throat," he says. He can’t take over-the-counter medications, he says. Too risky with his meds. There’s a backpack at his feet. He opens it, pulls out some tubing and a wide syringe, about a half-inch across, the kind you use to give medicine to horses.

"I don’t like the taste," he says.

He hooks the syringe to the tubing, lifts up his shirt. I think I’m supposed to pretend this is not happening. I’m driving. There’s a port under his shirt, connected to his stomach. I was not aware of that. He hooks the tubing to the port, so now the fat syringe is standing straight up.

He opens the Wild Turkey and starts pouring.

"Richard, I don’t think Dr. Rodriguez would want you doing this—"

All this talk of risk, all the meds, no smoking, no drinking, no falling. A lab rat. Everything measured and quantified and documented.

I pull over. There are no cars anywhere. We are deep into the mountain range.

He gets out, flips the syringe, emptying it. He gets back in and examines all the tubing, pinches this and that, allowing some stomach juices to squirt out.

"So that’s how you eat?" I ask. "You use the tube?"

"No," he says. He used to. He doesn’t need it anymore.

He reconnects everything, pours again. The whiskey goes quickly inside him, like water down a drain.

He looks at me. "This is how it’s supposed to work."

"This is for your throat?"

"I can’t take over-the-counter medication," he says again.

Everything about him is vague. Except this isn’t vague. He refills the syringe, lets another round drain into him, and another. I don’t know how much. It seems like a lot. I wonder what it will be like to be with a drunk Richard. I imagine his sister, the beautiful lookout place. It doesn’t happen. Within five minutes he folds, like a shot animal folds, over himself, folded, eyes open, his body deflated, the tube hanging out, dignity depleted.

"Richard?" I say. "Richard?" I shove his shoulder and nothing happens. He is dead. He is on my watch and he is dead. I hear gurgling. Breathing. He’s on my watch and he is not dead.

My watch?

The breathing is going in his mouth and out his nose. I am studying his face to make sure air is moving. In his mouth. Out his nose. This didn’t used to be his mouth or his nose. He can smell with that nose. He can chew food with a dead man’s jaw and teeth. There is no denying how fantastic that is.

I don’t know where to go. I don’t know one foggy mountaintop from another. I can’t wake him up.

I have his address in my GPS. I hit "previous destination." When we get to his house, I drag him out of the car, exactly the way you drag a drunk out of a car, one arm over my shoulder, little steps. I kick the etched bear on the storm door to open it.

"Hello? Hello?" I deposit him in his mom’s recliner, wait for someone to come home, or for him to wake up.

One day I ask Rodriguez how he picked Richard over the other candidates he had for his epic heroic story. "I had developed a relationship with Richard, so I knew the kind of person he is," he tells me. "This is an individual that I can trust as someone that can really care for this gift. Keep in mind, someone had to die for him to receive this face. So there’s a certain sense of responsibility and burden that I need to make sure that this is not going to be wasted. This has to be a responsible person that will share the precious gift and take this gift and make something with it, and of it."

"A lot of responsibility," I say.

"A lot," he says.

I ask him if he thinks people can get overly invested in the happily-ever-after in his line of work.

"Of course," he says. "Of course."

A recent article by Rodriguez in the medical journal The Lancet features before-and-after pictures of Richard. Side by side, the change is stunning, from a man with a mangled swirl of a face to regular guy. The more I look at the picture of Richard’s disfigured face, the more I wish I knew it. His eyes are bigger, rounder, provide a wider window. His eyebrows are all mid up, one curved sharply, the other a gentle swoop, thick scars in between. His lower face is cartoonish, like a drawing of an old guy who took his dentures out. There is so much to find in this face, so many avenues of inquiry.

Patient selection, Rodriguez writes in The Lancet, is the key to success when it comes to face transplantation. "Patient selection by a thorough screening process...serves as the best safeguard against ethical challenges," he writes. "Rigorous preoperative psychiatric and psychological selection of patients deemed to be stable, motivated, and compliant by a multidisciplinary team is a crucial determinant of a safe and rapid recovery."

The article looks back at all twenty-eight face transplants that have occurred and represents Rodriguez’s full circle from doubt to certainty. Three people have died from complications. Everyone else is said to be doing great.

NYU hospital issued a press release when the article was published, extolling Rodriguez’s call for a "moral imperative" to offer face transplants, the "Mount Everest" of medical-surgical treatments.

And yet while the debate about the ethics of face transplantation has shifted dramatically since the early days of harsh warnings against the procedure, researchers in a recent academic survey of the "successful" transplants note a distinct paucity of data on the psychological outcomes for these patients, who, they point out, often suffer from PTSD, alcohol abuse, and opiate dependence as a result of the trauma leading to their initial disfigurement.

Another journal article, in Anthropology Today, considered the topic under the heading "Ethical slippage and quiet death," with Richard’s picture occupying an entire page.

I try to tell Richard’s mom about the Wild Turkey, but this is a difficult conversation, and I’m not sure it’s the right thing to do. She’s in her recliner, and she has a migraine hangover. The medicine leaves her woozy. Eddie is over there feeding Slim Jims to Mark and Raven. Richard is in his room.

"Richard isn’t supposed to smoke," I start.

"Oh, I know," she says. "And you know, sometimes he drinks until he passes out."

I’m relieved, but not.

She talks about God. She talks about Rodriguez. Everything comes back to Rodriguez: "My godsend." That’s a lot of pressure on a savior. I wonder what exactly happened back in 1997 when Richard shot himself in the face. In an e-book version of the story, Richard says he was blindingly drunk, had come home and become verbally abusive with his mom, who sent him to his room to sleep it off. That part appears to be true, according to a police report filed in the Henry County Sheriff’s Office. But the rest of the story—that a shotgun happened to be tilted in a gun case and, upon coming out of his room, Richard was asked by his mom to straighten it, causing it to fire accidentally—appears to be apocryphal. According to the report: "Mrs. Norris was standing in the doorway of Richard’s bedroom; fussing at Richard about him wanting to go out again. Richard took a shotgun from his gun cabinet and told Mrs. Norris that he would just shoot himself. When Richard racked a shell into the shotgun’s chamber, the gun fired.... There was what appeared to be human flesh, bone, and teeth on all four walls in Richard’s bedroom." Mrs. Norris told police, "Richard’s face exploded."

It would take fifteen years to fix what had gone wrong that night—or at least to try to.

"The really weird thing is, me and Richard’s girlfriend found Dr. Rodriguez at the same time," his mom tells me. She pulls her blankets up. I’m sitting on the couch with Raven. Richard has joined us, is seated in the other recliner.

"Girlfriend?" I ask. Richard had a girlfriend before the transplant?

"She was looking online for doctors to help Richard same time I was," his mom says. "She found him same time as I did."

"Wait, who is this?"

"His girlfriend," she says. "Me and her could not get along."

"Girlfriend?" I say, looking over at Richard.

"An old one," he says. "Old, old. She was going to college to be a nurse."

I need a time-out. What year are we in? The accident happened in 1997. The new face didn’t come until 2012.

"You had a girlfriend when you were disfigured?" I ask Richard.

"I lived with her," he says. "For two years."

"When you were disfigured?"

"Yeah."

"But I thought you were a hermit," I say. What about the foggy mountaintop? The covered mirrors and the black mask?

Getting Richard Norris his new face wasn’t easy. For starters, doctors needed a donor who wasn’t just a favorable blood match but also had the proper skeletal features and skin color—they calculated only a 14 percent chance they’d find one. Then there was the epic surgery that took a team of 150 people. Now Richard just needs to win the daily battle against his body’s impulse to reject the face. Here’s what that routine entails. —Christopher Swetala

The First Days

To keep his highly sensitive face protected, Richard couldn’t so much as shave or brush his teeth. Abrasive contact could have damaged the sutures holding together the incisions, and even a scratch could have caused dangerous swelling and irritation.

The First Six Months

Richard was given large doses of drugs to help suppress his immune system and blunt rejection. But in his weakened state, a simple cold sore could have left him gravely ill, so doctors also gave Richard things like antiviral medication so he could fight off infections we’re all commonly exposed to when we do something as innocent as take a sip from a friend’s Coke. Those drugs came with risks, too—Richard was monitored for signs of diabetes, arthritis, and kidney failure. At times, he was taking some thirty pills each day through a feeding tube to his stomach.

The Rest of His Life

These days, Richard swallows three pills in the morning and two at night in order to keep his immune system at 50 percent strength—just enough to ward off common viral and bacteria infections but not so strong that his own antibodies attack his new face. In addition to avoiding things that tax his body—everything from the sun to cigarettes—Richard visits his doctors every month.

"This was during the whole stage of my disfigurement when I was working for race teams," Richard says. "When I was at the racetrack, it was like nobody didn’t care. They didn’t care what I looked like. Only thing they cared about was how good I could set that race car up."

"You had a job? And a girlfriend? And an apartment? You were living a whole life?"

"Yeah."

So why did he need a new face? Why had he endured the complications involved in freeing him from disfigurement? The thirty-six-hour operation, a 50 percent chance of dying on the table, a life of anti-rejection medications. No sunburn. No falling. Watch out for yellow. Two rejections so far.

"I didn’t like the girl," his mom says. "She tried to cut me out of everything."

There was a fight. At their apartment. Richard was convalescing after a surgery, and his mom came by. "She wouldn’t let me in to see Richard," she says. "So I went through her. And she told me, get out of her house, the doctor said nobody could see Richard. I said, ’I ain’t just nobody, I’m his mother. I’m gonna see him.’ I whopped her. And I had her on the floor. I just told her, I said, ’You don’t take my son away from me. Nobody takes my son.’ And she said, ’I’m gonna call the law.’ I said, ’Well, just call the law.’ "

"I got rid of her," Richard says.

"Then we moved up here in 2005, away from everybody," his mom says.

Which is right about the time they found Rodriguez.

"We don’t like it here," his mom says.

"It’s the most boringest place on earth," Richard says.

Being famous is better. One of Japan’s top fifty miracles. And he was willing to go through with getting a new face. And there was all that salvation his mom needed. And the wounded warriors needed him. And humanity needed him. And having a new face is better than some old disfigured one. You can’t argue with that.

Richard wishes Rodriguez had stayed in Baltimore. He doesn’t like New York. But wherever in the world Rodriguez needs him, he’ll be there. And yes, as to smoking, he shouldn’t. And yes, the incident in the car? "Uh-huh," he says. There’s a certain amount of self-medication, he says. "But that’s just self-medication." We’re at NYU again, and he’s not exactly sure what today’s event is. Some kind of fund-raiser, he thinks. We’re in the waiting room. He looks great in his suit. "I’m sure they’ll be very nice people," he says. He likes people. He likes visiting patients. People come to talk to Rodriguez, or the team back in Baltimore, and Richard joins them. They want face transplants. They want to know what it’s like. He tells them what it’s like. He knows exactly how they feel. It’s something positive he can do with his life. A face. "This is what I am," he tells me. "There is nothing more important than a face."

He brings up Hallam, the guy with the hand. "He couldn’t take it, so he had to cut it off," he says. "So now they say, ’Is the face transplant going to have that identity crisis, too?’ Well, if he does, we’re screwed."

A woman with curly dark hair peeks into the waiting room. "We’re ready!" she says. We head down the hall. Richard takes two steps into the conference room, and the people burst into spontaneous applause.

"Hi, Richard!"

"Hello, Richard!"

Rodriguez sits at the head of the table. Pretty little cookies are laid out. "This institute was made possible by these incredible people," he says to Richard.

"It’s our pleasure, Richard."

"God bless you."

"You’re very brave."

"You’re a real ambassador."

Richard thanks them on behalf of all the people in the future who might be helped. "A drop of hope can create an entire ocean," he says. "A little speck of faith can create a world. You give that speck of faith to them."

"He never really thought about himself in all of this," Rodriguez says. "He’s always thought about helping the wounded warriors and the other people, and providing hope. He’s a remarkable man."

"And they can do research on me as well," Richard says.

And that about wraps it up?

A woman has a question. She has wide shoulders, blond hair.

"What about your family?" she says. "Do they have therapeutic resources available to them to support you?"

"Actually, the support I get mainly is from therapists," Richard says. "They send me home with homework, give me ercises to practice, to help with my speech, my swallowing, you know. Physical therapy helps a whole lot, played a huge role in my recovery."

The woman tries again.

"Emotionally, did you feel you got the support you needed?"

"Emotionally I can get lab work done no matter where I am, if I’m home, if I’m in Baltimore. If I’m here, I get it done here. That way the lab work is always current."

I want to jump in here. I want to tell the woman with the questions about Wild Turkey, the poverty line, lab rats and wiener dogs, illness and violence.

Rodriguez jumps in. "The answer is yes and no," he says. "This is a new field. Every transplant has to be well thought out. One thing that you can appreciate with Richard is there was not a step missed in this rehearsal and this practice. And now Richard is our ambassador, and he can help us."

"You are one of the greatest people I’ve ever met," one in the crowd says to Richard.

Richard calls me shortly before he heads to New Orleans to meet Melanie, the new girlfriend. I wish him well. I feel nervous for him, want her to be real. For all his guile, he’s a trusting soul. And he needs a girlfriend or some companion to assist him through life. If there’s a future for him, it is almost assuredly off the foggy mountaintop. But under whose watch? Who will drive him around? He’s a science experiment. He’s a lab rat. He’s not a normal sort of boyfriend.

One day Melanie appears on my Skype screen. She’s real. She’s lovely. Richard is sitting next to her, waving to me. He wipes constant drool with the help of a towel. She just came home from work and put a pot roast in the oven. Richard folded the laundry. She wants to care for him. She finds a well of kindness in him. She’s been burned so many times. She says nothing about his medical-rock-star status, nothing about the drool. "Why does anyone fall in love?" she says with a shrug, when I ask about the relationship. She’s the first person I meet who talks about Richard as just a regular person. He’s not: a miracle. He’s not: a medical circus act. He’s not: an ambassador of anything. He’s a guy with barely a tick of a functioning immune system, thanks to the inexorable march forward of technology and a worldwide race for surgical glory. But for now, at least, she doesn’t need to have that conversation. I get the sense she would have liked Richard with his old face just the same.

In short order she introduces Richard to her kids, her mom; everybody likes everybody. She meets Richard’s mom by phone, and so far so good. One day she notices maybe a rash? "What is that?" she asks Richard. "I don’t think it’s anything," he says. He doesn’t want it to be anything. He’s finally with her, and he wants to stay. "I’m worried," she says. "It’s getting worse." She takes a picture of the rash, insists that Richard send it to the doctors in Baltimore keeping track of his medical care.

"Get here," they say. "Next plane out."

If it’s acute rejection and they can’t reverse it, he dies.

He’s hospitalized for two weeks, pumped full of stuff to get the rejection under control, then sent back to the foggy mountaintop to recover.

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